组织间近距离^(125)I放射性粒子治疗转移瘤硬膜外脊髓压迫症16例  

^(125)I radioactive seed interstitial brachytherapy for the treatment of metastatic epidural spinal cord compression

作　　者：陆健[1] 张丽云[1] 王忠敏[2] 滕皋军[3] 陈克敏[1] 陈志瑾[1] 贡桔[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院卢湾分院放射科,200020 [2]上海交通大学医学院附属瑞金医院瑞金医院介入科,200020 [3]东南大学医学院

出　　处：《介入放射学杂志》2015年第8期693-697,共5页Journal of Interventional Radiology

基　　金：上海市科委医学引导项目(124119b0800、134119b2900);上海市卫生局青年科研项目(20124Y062)

摘　　要：目的探讨125I放射性粒子组织间植入治疗转移瘤硬膜外脊髓压迫症(MESCC)的疗效及患者的生存质量。方法 16例无法手术或放疗的MESCC患者,在CT引导下行病灶内125I放射性粒子植入术。根据肿瘤大小植入粒子数6~45颗,粒子活度0.50~0.80 m Ci,肿瘤匹配周缘剂量(MPD)为80~140 Gy。应用视觉模拟评分(VAS)评价患者治疗前、后疼痛情况,应用美国脊髓损伤协会(ASIA)标准评价患者治疗前、后神经功能,卡氏评分评估患者治疗前、后身体功能状态。结果 16例患者疼痛明显缓解,VAS评分由治疗前(4.2±2.1)分下降至治疗后1个月(2.1±1.3)分,卡氏评分由治疗前(66.25±16.28)分提高至治疗后3个月时的(74.69±17.56)分,差异均有统计学意义(P<0.05)。神经功能保留率和恢复率分别为81.3%和50.0%。治疗后随访1~20个月,全组中位生存时间10个月。随访期间均未出现严重并发症。结论 125I放射性粒子组织间植入治疗MESCC可缩小肿瘤体积,减轻患者疼痛,改善患者生活质量和生存时间,是一种可选择的姑息性治疗方法。Objective To investigate the efficacy of 125I radioactive seed interstitial implantation for the treatment of metastatic epidural spinal cord compression （MESCC） and to evaluated the life quality of the patients. Methods Under CT guidance, interstitial implantation of 125I seeds was performed in 16 patients with MESCC who were unable to receive surgery or radiation therapy. The number of 125I seeds used in each patient ranged from 6 to 45 according to the tumor＇s size, and the particle activity ranged from 0.5 to 0.8 mCi. The tumor matched peripheral dose （MPD） was 80-140 Gy. Before and after the treatment, visual analogue scale （VAS） was used to evaluate the degree of pain for each patient, American spinal injury association （ASIA） standard was employed to assess the nerve function, and Karnofsky performance scale （KPS） was adopted to determine the physical function status. Results After the treatment, the pain was obviously alleviated in all 16 patients. VAS decreased from preoperative （4.19±2.10） points to postoperative （2.06± 1.34） points; KPS increased from preoperative （66.25±16.28） points to postoperative （74.69±17.56） points; and the differences in the changes were statistically significant （P〈0.05）. The neural function preservation rate and recovery rate were 81.25% and 50% respectively. All patients were followed up for 1-20 months, and the median survival time for all enrolled patients was 10 months. No severe complications occurred during the follow-up period. Conclusion In treating metastatic epidural spinal cord compression, 125I radioactive seed interstitial implantation can reduce tumor volume, relieve pain, improve the quality of life and prolong the survival time of the patients.

关 键 词：转移瘤硬膜外脊髓压迫症 CT引导 125I粒子 近距离治疗 

分 类 号：R730.5[医药卫生—肿瘤]